Background/Purpose: Enhancing rheumatology education in Internal Medicine (IM) residency may encourage residents to pursue rheumatology careers, and promote familiarity with rheumatology among those entering other fields. A needs assessment of rheumatology training in IM residency was conducted at an academic program (A) and community program (B) in the same city in 2021. At baseline, all third-year residents at B rotated in a rheumatology clinic for one month; A had no required rheumatology rotation. Neither program had structured rheumatology didactics. Surveys of residents and analysis of In-Training Exam (ITE) scores guided development of a rheumatology curriculum. An assessment of curriculum outcomes after the first year is presented.

Methods: A baseline survey was sent to all IM residents at A and B in Spring 2021, with questions on amount of rheumatology training in residency, interest in learning about rheumatology, interest and confidence in specific topics, and preferred curriculum formats. Results informed the curriculum, implemented starting August 2021. Noon conferences about rheumatology labs and systemic lupus erythematosus (SLE) were delivered at A and B, including pre- and post-quizzes and reference handouts. At A, conferences were also delivered on spondyloarthropathies and vasculitis, and each intern was scheduled for one half-day in rheumatology clinic. The survey was repeated in Spring 2022. ITE scores before and after curriculum implementation were compared (Fall 2020 and 2022).

Results: Baseline surveys were completed by 46% of residents (n=53) at A and 87% (n=20) at B. Post-surveys were by completed by 19% of residents (n=22) at A and 100% (n=23) at B. From 2021 to 2022, ratings of amount of rheumatology training in residency, interest in learning about rheumatology, and confidence in topics covered in conferences increased non-significantly (Figure 1). Preference for in-person curriculum formats increased at A and remained high at B (Figure 2). During the conference on labs, average quiz score increased at A: 40% (n=17, SD 26%) to 74% (n=20, SD 20%), and at B: 27% (n=6, SD 10%) to 77% (n=5, SD 15%). For the conference on SLE, average quiz score increased at A: 42% (n=8, SD 15%) to 90% (n=6, SD 17%), and at B: 52% (n=11, SD 10%) to 93% (n=14, SD 13%). From 2020 to 2022, scores on the rheumatology portion of the ITE increased from 65^th to 89^th national percentile at A, and decreased from 5^th to 4^thpercentile at B. Ranking ITE performance in the 11 IM subspecialties by percentile, A’s rheumatology scoreincreased from 10^th to 3^rd (tied) subspecialty, while B’s decreased from 6^th (tied) to 10^th (tied).

Conclusion: Implementation of a rheumatology curriculum resulted in several advances after one year; outcomes varied between two programs. Residents demonstrated knowledge gains during conference sessions at both A and B. Rheumatology ITE score percentile improved only at A, which received additional didactics. Resident-reported metrics of their rheumatology training improved slightly at both. Preferred curriculum formats shifted from virtual to in-person from 2021 to 2022. Incomplete resident participation at A was a limitation. Next steps include adding additional conferences and reference materials.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/outcomes-of-the-first-year-of-a-rheumatology-curriculum-at-two-internal-medicine-residency-programs/